海南地区胆结石患者感染菌群及术后护理效果的评价

Distribution characteristics of biliary bacteria and postoperative care in patients with cholelithiasis

目的:分析海南地区胆结石患者胆道感染的菌群分布特点,探讨胆道感染革兰氏阳性菌(Gram-positive bacteria,G+)和革兰氏阴性菌(Gram-negative bacteria,G-)与术后护理的关系.方法:按照术中胆汁培养结果将海南省人民医院收治的96例胆结石并感染的患者分为G+组16例和G-组80例,观察胆汁样本致病菌分离培养结果,比较G+组与G-组患者流行病学分布、感染情况、手术切口愈合等级术后T型管拔除时间、更换无菌敷料次数及拆线时间.结果:96例胆汁样本共培养G+菌16株(16.67%),包括肠球菌15株、葡萄球菌1株,G-菌80株(83.33%),包括大肠埃希菌51株、肺炎克雷伯杆菌13株、铜绿假单胞菌6株、阴沟肠杆菌4株、其他6株;两组患者感染情况和手术切口愈合等级比较,(6.25%vs 20.00%)、(93.75%vs 80.00%)、(18.75%vs 11.25%)、(62.50%vs 67.50%)、(12.50%vs 1.25%)、(0.00%vs 15.00%)、(0.00%vs 3.75%)、(6.25%vs 0.00%)、(0.00%vs 1.25%),差异无统计学意义(P>0.05);G+组患者术后T型管拔除时间、更换无菌敷料次数及拆线时间均少于G-组,(16.81 d±2.69 d vs 23.52 d±10.01 d)、(8.42次±4.29次vs 14.71次±11.70次)、(9.24 d±1.48 d vs 13.54 d±6.62 d),差异具有统计学意义(P<0.05).结论:海南地区胆结石并胆道感染患者胆汁病原菌以G-菌为主,其中大肠埃希菌最为常见,术后应加强对G-菌感染组T型引流管和手术切口护理,防止引流管脱出、促进切口愈合、降低换药次数.

AIM： To analyze the distribution of biliary bacte-ria and postoperative care in patients with chole-lithiasis and to explore the relationship between the Gram-positive（G＋） bacteria, Gram-negative（G-） bacteria and postoperative care.METHODS： Ninety-six patients with gallstones and infection were divided into either a G＋ group（n = 16） or a G- group（n = 80） according to the results of bile culture. The culture results of pathogenic bacteria in bile samples were analyzed, and the epidemiological distribution, infection, incision healing, T tube removal time, number of sterile dressing changes, and suture removal time were compared between the two groups.RESULTS： In 96 bile samples, 16（16.67%） G＋ strains were isolated, including 15 Enterococcus strains and 1 Staphylococcus strain; 80（83.33%）G- strains were isolated, including 51 Escherichia coli strains, 13 Klebsiella pneumoniae strains, 6 Pseudomonas aeruginosa strains, 4 Enterobacter cloacae strains, and 6 other strains. There were no significant differences in the rates of infection and incision healing（6.25% vs 20.00%, 93.75% vs 80.00%, 18.75% vs 11.25%, 62.50% vs 67.50%, 12.50% vs 1.25%, 0.00% vs 15.00%, 0.00% vs 3.75%, 6.25% vs 0.00%, 0.00% vs 1.25%, P〈0.05） between the two groups. The time to T tube re-moval, the number of sterile dressing changes, and the time to suture removal were significant-ly lower in the G＋ group than in the G- group（16.81 d ± 2.69 d vs 23.52 d ± 10.01 d, 8.42 ± 4.29 vs 14.71 ± 11.70, 9.24 d ± 1.48 d vs 13.54 d ± 6.62 d, P〈0.05）.CONCLUSION： The main pathogens in patients with cholelithiasis and biliary tract infection are G- bacteria, with E. coli being the most common. The postoperative care of T tube and operative incision should be enhanced in patients with G- bacterial infection to promote wound healing and reduce the number of dressing changes and patient care costs.